Healthcare Provider Details

I. General information

NPI: 1972099232
Provider Name (Legal Business Name): ROBERT MICHAEL O'CONNOR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S OYSTER BAY RD
PLAINVIEW NY
11803-3310
US

IV. Provider business mailing address

9 TEAMSTER LN
LEVITTOWN NY
11756-5225
US

V. Phone/Fax

Practice location:
  • Phone: 516-888-4357
  • Fax:
Mailing address:
  • Phone: 516-361-9695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number103835-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: